Treatment Bible

Part III of D'Adesky's book is basically the Bible of for all things treatment related. D'Adesky summarizes the benefits of HIV treatment:

• Contrary to previous beliefs, treatment can world in developing settings. (look at Brazil, Cuba etc.)
• It allows countries to build up their infrastructures (through additional foreign and humanitarian aid) and can provide models of care for other diseases
• Relieves the suffering of thousands, and is the morally and ethically appropriate thing to do.

Ok, great. As for developing settings, its great that its working in small, pilot programs but I will be interested to see where the disease is 10 years from now. And I completely agree that it is necessary for countries to build strong health infrastructures. But is it wise to build them around one disease? As we saw in the Russian model, individual treatment centers for AIDS, TB, STI's and any other disease led to increased bureaucracy, confusion for HIV patients that had all three of these infections, and led to increased stigma by broadcasting to the community which disease you have.

And who can argue against the ethical argument?

However, for the next 50 or so pages D'Adesky highlights the barriers to care...

• adverse affects
• multi Drug Resistant-HIV
• costs of second-line therapies
  
• lack of food, resulting in difficulty swallowing ARV medications
• lack of clean water sources
  
• adherence issues, namely cost of medications
• superinfection (when an HIV positive person develops a more powerful, resist strain of HIV
• other Opportunistic Infections's (TB, Malaria, etc.) that can interfere with ARV regimens
  
• difficulties associated with treating children, women, and hard to reach population such as drug users.
• potential development of new not treatable strains of virus
  
• complicated training and human resource issues (medical literacy, different drug regimens etc.)
• ethical issues associated with research

Hmm...so I'm nearly at the end of the book and I still can't say that I'm sold on the whole new treatment model hype. Maybe the next chapter will change my mind...